Physical Fatigue, Fitness, and Muscle Function in Patients With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Andrew McClean, Matthew D Morgan, Neil Basu, Jos A Bosch, Peter Nightingale, David Jones, Lorraine Harper

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

ObjectiveThis study investigated differences in cardiorespiratory fitness, muscular function, perceived exertion, and anxiety/depression between patients and healthy controls (HCs) and assessed which of these variables may account for the fatigue experienced by patients.MethodsFatigue was measured in 48 antineutrophil cytoplasmic antibody–associated vasculitis patients and 41 healthy controls using the Multidimensional Fatigue Inventory (MFI-20), focusing on the physical component. Quality of life, anxiety/depression, and sleep quality were assessed by validated questionnaires. Muscle mass was measured by dual-energy x-ray absorptiometry scan, strength as the maximal voluntary contraction (MVC) force, and endurance as sustained isometric contraction at 50% MVC of the quadriceps. Voluntary activation was assessed by superimposed electrical stimulation. Cardiorespiratory fitness ( and oxygen pulse [O2 pulse]) and perceived exertion (Borg scale) were measured during progressive submaximal exercise.ResultsPatients reported elevated physical fatigue scores compared to HCs (patients MFI-20 physical 13 [interquartile range (IQR) 8–16], HCs MFI-20 physical 5.5 [IQR 4–8]; P < 0.001). Muscle mass was the same in both groups, but MVC and time to failure in the endurance test were lower due to reduced voluntary activation in patients. Estimated and O2 pulse were the same in both groups. For the same relative workload, patients reported higher ratings of perceived exertion, which correlated with reports of MFI-20 physical fatigue (R2 = 0.2). Depression (R2 = 0.6), anxiety (R2 = 0.3), and sleep disturbance (R2 = 0.3) were all correlated with MFI-20 physical fatigue.ConclusionThese observations suggest that fatigue in patients is of a central rather than peripheral origin, supported by associations of fatigue with heightened perception of exertion, depression, anxiety, and sleep disturbance but normal muscle and cardiorespiratory function.
Original languageEnglish
Pages (from-to)1332-1339
Number of pages8
JournalArthritis Care & Research
Volume68
Issue number9
Early online date29 Dec 2015
DOIs
Publication statusPublished - Sept 2016

Bibliographical note

© 2015, American College of Rheumatology.

Funding
This work was supported by University Hospitals Birmingham Charity (AM 10/2010). The funder had no role in study design, data collection, analysis, interpretation of data, writing the report or the decision to submit the report for publication.

Acknowledgements
The work was carried out at the National Institute for Health Research (NIHR)/Wellcome Trust Birmingham Clinical Research Facility. The views expressed are those of the author(s) and not
necessarily those of the NHS, the NIHR of the Department of Health. All authors have contributed to the study design, data collection, analyses and drafting of the manuscript and agreement of the final version for publication.

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